Soo, Yannie; Zietz, Annaelle; Yiu, Brian; Mok, Vincent C T; Polymeris, Alexandros A; Seiffge, David; Ambler, Gareth; Wilson, Duncan; Leung, Thomas Wai Hong; Tsang, Suk Fung; Chu, Winnie; Abrigo, Jill; Cheng, Cyrus; Lee, Keon-Joo; Lim, Jae-Sung; Shiozawa, Masayuki; Koga, Masatoshi; Chabriat, Hugues; Hennerici, Michael; Wong, Yuen Kwun; ... (2023). Impact of Cerebral Microbleeds in Stroke Patients with Atrial Fibrillation. Annals of neurology, 94(1), pp. 61-74. Wiley 10.1002/ana.26642
Full text not available from this repository. (Request a copy)OBJECTIVES
Cerebral microbleeds are associated with the risks of ischemic stroke and intracranial hemorrhage, causing clinical dilemmas for antithrombotic treatment decisions. We aimed to evaluate the risks of intracranial hemorrhage and ischemic stroke associated with microbleeds in patients with atrial fibrillation treated with Vitamin K antagonists, direct oral anticoagulants, antiplatelets, and combination therapy (i.e. concurrent oral anticoagulant and antiplatelet) METHODS: We included patients with documented atrial fibrillation from the pooled individual patient data analysis by the Microbleeds International Collaborative Network. Risks of subsequent intracranial hemorrhage and ischemic stroke were compared between patients with and without microbleeds, stratified by antithrombotic use.
RESULTS
A total of 7,839 patients were included. The presence of microbleeds was associated with an increased relative risk of intracranial hemorrhage (aHR 2.74, 95% confidence interval 1.76 - 4.26) and ischemic stroke (aHR 1.29, 95% confidence interval 1.04 - 1.59). For the entire cohort, the absolute incidence of ischemic stroke was higher than intracranial hemorrhage regardless of microbleeds burden. However, for the subgroup of patients taking combination of anticoagulant and antiplatelet therapy, the absolute risk of intracranial hemorrhage exceeded that of ischemic stroke in those with 2-4 microbleeds (25 vs 12 per 1,000 patient-years) and ≥11 microbleeds (94 vs 48 per 1,000 patient-years).
INTERPRETATION
Patients with atrial fibrillation and high burden of microbleeds receiving combination therapy have a tendency of higher rate of intracranial hemorrhage than ischemic stroke, with potential for net harm. Further studies are needed to help optimize stroke preventive strategies in this high-risk group. This article is protected by copyright. All rights reserved.
Item Type: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology |
UniBE Contributor: |
Seiffge, David Julian, Göldlin, Martina Béatrice, Panos, Leonidas, Jung, Simon |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
1531-8249 |
Publisher: |
Wiley |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
20 Mar 2023 10:05 |
Last Modified: |
30 Jun 2023 00:13 |
Publisher DOI: |
10.1002/ana.26642 |
PubMed ID: |
36928609 |
URI: |
https://boris.unibe.ch/id/eprint/180301 |
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